Healthcare Provider Details

I. General information

NPI: 1659743292
Provider Name (Legal Business Name): FADI JAAFAR DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 MARY CT
ALMA MI
48801-1053
US

IV. Provider business mailing address

1469 MARY CT
ALMA MI
48801-1053
US

V. Phone/Fax

Practice location:
  • Phone: 989-463-2150
  • Fax:
Mailing address:
  • Phone: 989-463-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FADI JAAFAR
Title or Position: PRESIDENT
Credential: DPM
Phone: 989-463-2150